1/12. Giant cervico-mediastinal lipoma. A clinical case.The lipoma is a circumscribed mesenchymal tumour originating from adipose tissue. The lesion is usually small and asymptomatic, and is most frequently located in the neck region. The case of a 77-year-old woman with chronic extrasystolic arrhythmia caused by a non-specified ischemic cardiopathy is reported. The woman presented a swelling at the front of her neck, observed for the first time about 6 months previously. This swelling progressively increased in size, provoking dysphagia, dysphonia, persistent cough, dyspnea, light jugular turgor and palpitations. Chest x-rays showed and opaque area at the front of the neck, which extended beyond the jugular incisure by about 2 cm. NMR of the neck showed a gross lipomatous formation at the front, mainly of the left, continuing in the front mediastinal region; the trachea was dislocated to the right and compressed at the back; the vasculo-nervous fasciculus, especially on the left, was compressed and enveloped by the adipose formation. The Holter test confirmed the presence of ventricular and supra-ventricular extrasystoles. Surgery was carried out under local anaesthesia because the displacement of the laryngo-tracheal axes precluded intubation. Histological analysis of the 9 x 4 x 2.2 cm mass confirmed the diagnosis of lipoma. After removal of the mass all the symptoms, which had been provoked by compression, as well as the cardiac arrhythmias disappeared. The prompt disappearance of the latter was particularly surprising. The possibility of the external compression of the nervous structures of the neck should be taken into consideration in cases of ventricular arrhythmia of unknown origin, and systematic study of the region carried out.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/12. Mediastinal mass obscured by a large pericardial effusion in a child: a potential cause of serious anaesthetic morbidity.Anaesthesia in the presence of a mediastinal mass is known to be hazardous. We report a case of a 5-year-old boy with a presumed postviral pericardial effusion presenting for pericardiocentesis under general anaesthesia. Cardiorespiratory collapse following induction of anaesthesia occurred due to an undiagnosed mediastinal tumour. The reasons for misdiagnosis, mechanisms for perioperative complications and optimal management are discussed. Mediastinal masses and underlying malignancy should always be considered in patients with large pericardial effusions.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/12. Daily general anaesthesia for radiotherapy in unco-operative patients: ingredients for successful management.An unco-operative patient requiring daily radiation therapy presents a difficult clinical problem. After reviewing the paediatric oncology literature addressing the use of general anaesthesia for short medical procedures, we have developed checklists of procedural guidelines and monitoring equipment for the safe use of daily anaesthesia in adult patients who require a fractionated course of radiation therapy. We illustrate this by describing the successful treatment of a woman with autism and Hodgkin's disease who required daily general anaesthesia for immobilization during a 4-week course of radiation therapy. propofol was used as the primary drug and was not associated with any adverse side-effects. There was no development of tolerance.- - - - - - - - - - ranking = 7keywords = anaesthesia (Clic here for more details about this article) |
4/12. Wheeze and mediastinal mass: a challenging patient.airway obstruction is a recognized complication in children with mediastinal masses. They typically present with difficulty in breathing and associated respiratory noises. General anaesthesia in these patients can lead to complete airway obstruction with fatal consequences. Successful management in the ED necessitates rapid recognition of the underlying problem and appropriate intervention. We report the case of a 7-year-old boy presenting with respiratory collapse and describe the management that led to successful resuscitation.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/12. Unusual presentation of acute upper airway obstruction caused by an anterior mediastinal mass.We report an unusual case of acute upper airway obstruction. inhalation of a foreign body caused choking in a 5-yr-old child, but subsequent investigations revealed a large anterior mediastinal tumour, externally compressing the trachea and the main bronchi. Such a presentation may be deceptive and is important, as general anaesthesia may result in complete airway obstruction with fatal consequences.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/12. A boy with an anterior mediastinal mass.A 12-year-old boy presented for biopsy of a large mediastinal mass. General anaesthesia precipitated immediate severe airway obstruction. This was overcome by the insertion of two microlaryngeal tubes, one into each main bronchus. The anaesthetic management of patients with an anterior mediastinal mass is discussed and the importance of pre-operative assessment stressed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/12. Anaesthetic complications of mediastinal masses and superior vena caval obstruction.Two patients with mediastinal tumour and superior vena caval obstruction who, after general anaesthesia, experienced respiratory difficulties requiring intubation or reintubation are presented. Possible aetiological mechanisms are discussed in relation to these cases.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
8/12. Mediastinal obstruction of the trachea.Acute tracheal obstruction by a mediastinal mass is uncommon in otolaryngologic practice. Choosing techniques for securing the airway, induction of anaesthesia, and the surgical approach require careful deliberation. We report our experience in a patient with acute respiratory distress due to external compression of the trachea in the mediastinum by metastatic carcinoma. We used a fibre-optic bronchoscope ensheathed by an endotracheal tube to secure the airway. Standard tracheotomy tubes were too short to splint open the obstruction in the distal trachea, whereas the long Montgomery T-tube was effective.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/12. A patient presenting for pharyngeal biopsy.A 68-yr-old man presented for pharyngeal biopsy under general anaesthesia. Coincidentally he was found to have a large mediastinal mass. The evaluation of this patient is described. The exact risk of catastrophic airway collapse on induction of anaesthesia in patients with mediastinal masses is controversial but probably small. As there is no test to prevent airway collapse, it is suggested that attempts at biopsy be performed with regional anaesthesia after radiotherapy.- - - - - - - - - - ranking = 3keywords = anaesthesia (Clic here for more details about this article) |
10/12. Intrapleural analgesia in a child with a mediastinal tumour.A case is presented of an eight-year-old child with a mediastinal tumour, who had developed acute renal failure following the institution of steroid therapy. Intrapleural analgesia was successfully used for the insertion of a peritoneal dialysis catheter so that the considerable risks of general anaesthesia were avoided. Subsequent dialysis allowed chemotherapy to commence and, as a result of the shrinkage in tumour size, general anaesthesia was administered safely two days later. The purpose of this report is to highlight the use of intrapleural analgesia in children as an alternative to general anaesthesia, when the latter is contraindicated. The mechanism of action of intrapleural analgesia and the risks of anaesthesia in the presence of a mediastinal tumour are discussed.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
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